Deciding whether to take call in the ED

Ethics Forum. Nov. 5, 2007.

Is it ethical to leave hospital and emergency care to others?

Specialists in private practice increasingly limit their work exclusively to outpatient care in private offices, leaving patients' hospital care to others still at the hospital. What is the impact?

Response

When colleagues stop taking emergency department and hospital call and expect people like me to take care of their patients who get sick, I feel abused. Even though their patients get the care they need, are free to change physicians and aren't subject to unfair discrimination, it's not as if nobody gets hurt. I do. And so do others like me.

Doctors who leave hospital and ED care to others violate the cardinal rule learned early in internship: One never, never, dumps dirty work on a colleague. Being a physician implies an obligation not only to our patients, but to each other. We must share the pain if we are to be permitted to share the rewards. We are not a fraternity, but a community. I believed it when I learned it, and I believe it still.

It's not so simple, you say. You're right. I understand the other side of the story, and it deserves to be heard.

Nobody I know went into medicine for the money. Sure, people get caught up in it, but that wasn't the point for any doctor I know. It's just that matters get complicated in a system that keeps demanding that we change how we do things, for reasons only rarely having to do with helping patients.